Healthcare Provider Details

I. General information

NPI: 1003500414
Provider Name (Legal Business Name): AALOK DEEP BISHWAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE
TULSA OK
74104-6520
US

IV. Provider business mailing address

1923 S UTICA AVE ASCENSION ST. JOHN MEDICAL CENTER
TULSA OK
74104-6520
US

V. Phone/Fax

Practice location:
  • Phone: 845-420-0558
  • Fax:
Mailing address:
  • Phone: 845-420-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47384
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: